Immediate Treatment of Extreme Trauma

As a psychiatrist treating PTSD in Israel for many decades, my experience with current available regimens is sobering. Here are the main points:

• Israel is certainly a world leader in expertise in a variety of pyschotherapeutic approaches ranging from Somatic Experience to Prolonged Exposure to meditations. Many many people are assisted with these aproaches, but not all.
• Psychotherapies are very helpful in only a proportion of the population. Many victims of severe trauma find themselves unable to speak of the trauma without becoming overwhelmed emotionally and unable to make productive change.
• Psychopharmacology has very little to offer in PTSD. An update in 2022 should be read as presenting an uncertain “gold standard”  which is far from impressive. This concurs with my experience.
• Medical cannabis can be helpful in alleviating symptoms and making the psychotherapies more effective. While I have recently argued for immediate legalization in view of the hopelessly inept management of medical cannabis in general and especially in face of our enormous crisis, I have no hopes for constructive change here.
• The grim conclusion is that there are thousands of Israelis in desperate need of immediate and effective treatment who will be under-treated, a situation which is likely to create a huge backlog of more chronic PTSD suffering for the future.

In this situation, if there could be a treatment that could respond rapidly, have few if any side effects and could be made available quickly, it surely is worth the try.

THE STELLATE GANGLION BLOCK IS SUCH A TREATMENT

The scientific reasoning behind this treatment is that it is overactivity of the sympathetic nervous system that creates the extreme and unrelenting tension which is central to the symptoms of PTSD. Injection of a simple local anesthetic into the group of nerves (ganglion) easily approached by a superficial injection in the neck seems able to reduce this overactivity. The procedure has been used with practically no side effects since 1925 for other conditions, and since the 1990s and especially in the past decade has produced surprisingly good effects on of US Veterans suffering severe PTSD. One of its innovators has recently trained an expert Israeli team just this year, now active in Haifa and Tel Aviv.

When I heard about it from a PTSD client who underwent the treatment, I invited myself to observe the procedure in Tel Aviv. Dr. Jason Cohen, an extremely well-trained interventive anesthesiologist performs the injection expertly and pleasantly in about 15 minutes. The first client I referred suffered from 50 years of PTSD, slept well “for the first time I can recall” after the treatment and awakened wondering where the tension had gone. She is now two months after the procedure with lasting effects.

I had planned to follow about a dozen clients before writing this blog, but then October 7th happened. As of this writing I have followed 6 clients who have suffered no side effects and have had extraordinary results. One client, whose diagnosis is quite uncertain, had no benefit. This would normally be a matter for slow and methodical medical research; what is it doing in this blog?

While the Health Ministry allows the procedure to be performed for documented PTSD, molasses move more quickly than Israeli institutions. Even the Defense Department has not approved it for PTSD, as Dr. Cohen informs me, because Israel’s “PTSD Experts” are not “convinced.” Needless to say, the Sick Funds do not cover it. The cost of the procedure, which requires sterile conditions of a minimal operating theatre, is 8000 NIS. The company sponsoring the treatment has raised grants to reduce the cost by up to half. That is where things stand as I thought to begin blogging to move the treatment ahead.

BUT WE CANNOT AFFORD TO WAIT NOW! In my opinion as a physician of nearly 50 years, this is a procedure that cannot wait for molasses. Thousands of traumatized Israelis need immediate treatment, all of the “experts” cannot treat them and many will not respond to talking treatments, drugs are a very limited help, cannabis is all but kaput, and a 15 minute injection with no real danger could potentially relieve a great deal of suffering. I call for the Defense Department and the Sick Funds to immediately recognize this procedure and fund it for the next six months. 

This in not just a no-brainer. As Adi Ofer defines the Hebrew “AVLA” (wickedness), withholding the availability of a safe, promising, albeit yet to be “proven” treatment in Israel in October 2023 would constitute the systematic perpetuating of unnecessary suffering.